These authors contributed equally to the study.
Liver Failure/Cirrhosis/Portal Hypertension
Insulin resistance is a risk factor for esophageal varices in hepatitis C virus cirrhosis†
Article first published online: 26 SEP 2008
Copyright © 2008 American Association for the Study of Liver Diseases
Volume 49, Issue 1, pages 195–203, January 2009
How to Cite
Cammà, C., Petta, S., Di Marco, V., Bronte, F., Ciminnisi, S., Licata, G., Peralta, S., Simone, F., Marchesini, G. and Craxì, A. (2009), Insulin resistance is a risk factor for esophageal varices in hepatitis C virus cirrhosis. Hepatology, 49: 195–203. doi: 10.1002/hep.22655
Potential conflict of interest: Nothing to report.
- Issue published online: 28 DEC 2008
- Article first published online: 26 SEP 2008
- Accepted manuscript online: 26 SEP 2008 12:00AM EST
- Manuscript Received: 5 SEP 2008
Indirect methods to predict the presence of esophageal varices (EV) in patients with cirrhosis are not sensitive enough to be used as a surrogate for endoscopy. We tested the effectiveness of liver stiffness measurement (LSM) by transient elastography and the presence of insulin resistance (IR), a marker associated with fibrosis progression, in the noninvasive prediction of portal hypertension. One hundred four consecutive patients with newly diagnosed Child A hepatitis C virus (HCV) cirrhosis underwent upper gastrointestinal endoscopy to search for EV. Clinical, anthropometric, biochemical, ultrasonographic, and metabolic features, including IR by the homeostasis model assessment (HOMA), and LSM by transient elastography, were recorded at the time of endoscopy. EVs were detected in 63 of 104 patients (60%). In 10 patients (16%), the EVs were medium-large (≥F2). By multivariate analysis, the presence of EVs was independently associated with a low platelet count/spleen diameter ratio (OR, 0.998; 95% CI, 0.996-0.999) and a high HOMA-IR score (OR, 1.296; 95%CI, 1.018-1.649), not with LSM (OR, 1.009; 95%CI, 0.951-1.070). It is noteworthy that nine of ten patients with medium-large EVs had a platelet/spleen ratio of less than 792 or an HOMA-IR of greater than 3.5. The independent association between low platelet count/spleen diameter ratio (OR, 0.998; 95%CI, 0.996-1.000), high HOMA-IR score (OR, 1.373; 95%CI, 1.014-1.859) and presence of EV was confirmed in the subgroup of 77 nondiabetic subjects. Conclusions: In patients with Child A HCV cirrhosis, two simple, easy-to-get tests, namely the platelet/spleen ratio and insulin resistance measured by HOMA-IR, regardless of the presence of diabetes, significantly predict the presence of EV, outweighing the contribution given by transient elastography. (HEPATOLOGY 2009;49:195-203)